Healthcare Provider Details

I. General information

NPI: 1114936994
Provider Name (Legal Business Name): KATIE WETHERILL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE MORGAN APN

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/20/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BROAD ST STE 606
NEWARK NJ
07102-4537
US

IV. Provider business mailing address

134 ARCH ST APT 501
PHILADELPHIA PA
19106-2266
US

V. Phone/Fax

Practice location:
  • Phone: 201-822-1161
  • Fax: 877-485-8918
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00103500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number26NJ00103500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: